Andy Molyneux

University of Oxford | OX · Nuffield Department of Surgical Sciences

Introduction The US Woven EndoBridge Intra-saccular Therapy (WEB-IT) study is a pivotal, prospective, single arm, investigational device exemption study to evaluate the safety and effectiveness of the WEB device for the treatment of wide neck bifurcation aneurysms (WNBAs). We present complete 5 year data for the cohort of 150 patients. Methods 150...

Background Evaluating a new endovascular treatment for intracranial aneurysms must not only demonstrate short-term safety and efficacy, but also evaluate longer-term outcomes (eg, delayed complications, anatomical results, retreatment). The current analysis reports the 5-year clinical and anatomical results of Woven EndoBridge (WEB) treatment in tw...

Background Evaluating a new endovascular treatment for intracranial aneurysms must not only demonstrate short-term safety and efficacy, but also evaluate longer term outcomes (e.g., delayed complications, anatomical results, retreatment). The current analysis reports the 5-year clinical and anatomical results of WEB treatment in two European combin...

Background WEB treatment is an endovascular approach for wide-neck bifurcation aneurysms that has demonstrated high safety and good efficacy in mid-term follow-up. While evaluating safety in the long term is important to determine if delayed adverse events occur affecting late morbidity and mortality, the most important point to evaluate is the lon...

Introduction The Woven EndoBridge Intrasaccular Therapy (WEB-IT) Study is a pivotal, prospective, single-arm, investigational device exemption study designed to evaluate the safety and effectiveness of the WEB device for the treatment of wide-neck bifurcation aneurysms. Methods One-hundred and fifty patients with wide-neck bifurcation aneurysms we...

Introduction Wide-necked bifurcation aneurysms (WNBAs) present unique technical challenges for both endovascular and surgical treatments which aim to achieve complete occlusion of the aneurysm without compromising the patency of the incorporated regional parent vessels. We present a meta-analysis of traditional therapies for WNBAs to provide critic...

Introduction Si le traitement endovasculaire par coiling est desormais la premiere option therapeutique dans la prise en charge des anevrismes intracrâniens, cette approche presente encore certaines limites, notamment pour les anevrismes a collet large. Ceci a conduit au developpement de nouvelles techniques endovasculaires (remodelling, stenting,...

Purpose WEB Flow disruption is an innovative endovascular treatment for wide-neck bifurcation aneurysms. This treatment was already evaluated in several retrospective and prospective series, including 2 Good Clinical Practice (GCP) studies (WEBCAST and French Observatory) showing high safety and good efficacy. In WEBCAST, all patients were treated...

Purpose WEB Flow disruption is an innovative endovascular treatment for wide-neck bifurcation aneurysms. Three prospective multicenter GCP (Good Clinical Practice) studies were conducted in Europe (WEBCAST, French Observatory, WEBCAST2). Safety and efficacy data are analyzed in the cumulated population of these 3 studies. Methods Patients with wid...

Background Flow Disruption with WEB is an innovative endovascular approach for wide-neck bifurcation aneurysms. Multiple prospective, multicenter good clinical practice (GCP) studies to date (WEBCAST, French Observatory, WEBCAST 2) have shown a low complication rate with good efficacy. Objective To report demographic, procedural data and initial 3...

Background and purpose: Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, incl...

Objective: We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. Methods: An international multidisciplinary (neur...

Purpose WEB Flow disruption is an innovative endovascular treatment for wide-neck bifurcation aneurysms. Two prospective multicenter GCP (Good Clinical Practice) studies were conducted in Europe and inclusions were completed in February 2014 in both trials. Safety and efficacy data are analyzed. Methods Patients with wide neck bifurcation aneurysms...

Purpose WEB flow disruption is an innovative endovascular treatment for wide-neck bifurcation aneurysms. WEBCAST1 analyzed the safety and efficacy of the WEB-DL device. WEBCAST2 is dedicated to the safety and efficacy analysis of the WEB-SL and WEB-SLS device. Methods WEBCAST2 is a prospective, multicenter, European study involving 13 Interventiona...

Safety analyses in the French Observatory have shown that treatment of intracranial aneurysms by using flow disruption with the Woven EndoBridge Device (WEB) is safe, with low morbidity and no mortality. The objective of this study was to analyze treatment feasibility, complications, and safety results in patients treated with the Woven EndoBridge...

Objective: The WEB (WEB aneurysm embolization system, Sequent Medical, Aliso Viejo, California, USA) is a self-expanding, nitinol, mesh device designed to achieve aneurysm occlusion after endosaccular deployment. The WEB Occlusion Scale (WOS) is a standardized angiographic assessment scale for reporting aneurysm occlusion achieved with intrasaccul...

Background and purpose WEBCAST is a European study dedicated to the evaluation of the feasibility, safety, and efficacy of endovascular treatment with WEB of intracranial aneurysms. Materials and methods The study was conducted in 10 European centers. Inclusion criteria were aneurysms located at internal carotid artery bifurcation, middle cerebral...

Background and purpose: Anterior communicating artery aneurysms account for one-fourth of all intracranial aneurysms and frequently occur in the context of A1 vessel asymmetry. The purpose of this study was to correlate circle of Willis anatomic variation association to angiographic and clinical outcomes of anterior communicating aneurysm coiling....

Background and purpose: There is controversy as to the best mode of treating MCA aneurysms. We report the results of a large endovascular series of patients treated at our center. Materials and methods: This study was a retrospective analysis of a prospectively acquired data base. All patients with saccular MCA aneurysms treated between November...

Background and purpose: Independent evaluation of angiographic images is becoming widely applied in the assessment of treatment outcomes of cerebral aneurysms. In the current study, we assessed the agreement between an independent core laboratory and the operators regarding angiographic appearance in a recent randomized, controlled trial. Materia...

We report here results of a randomized, double-blind, placebo-controlled study ( http://www.ClinicalTrials.gov , NCT00558311) that investigated the effect of clazosentan (5 mg/h, n = 768) or placebo (n = 389) administered for up to 14 days in patients with aneurysmal subarachnoid hemorrhage (SAH) repaired by surgical clipping. The primary endpoint...

The International Subarachnoid Aneurysm Trial (ISAT) was a major study comparing clipping and coiling of ruptured intracranial aneurysms. The trial provided answers that were the subject of multiple letters and editorial comments. We review the most common critiques that were published in major neurosurgical journals, trying to identify what aspect...

Une population de Culex pipiens, prélevée en 1979 au sein d'une zone régulièrement traitée, a été soumise en laboratoire pendant plus de 30 générations à différents régimes d'élevage (en exerçant ou non une pression de sélection au chlorpyrifos). L'analyse des différentes souches issues de cette population a permis de montrer : 1) qu'un ou plusieur...

Contexte et objectifs L’étude International Subarachnoid Aneurysm Trial (ISAT) sur les anévrismes fut une étude marquante. ISAT effectua une comparaison entre le clipping et le coiling des anévrismes intracrâniens rompus, et fournit des réponses qui furent abondamment commentées dans de multiples lettres et remarques éditoriales. Méthodes Les crit...

Clazosentan, an endothelin receptor antagonist, has been shown to reduce vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). CONSCIOUS-3 assessed whether clazosentan reduced vasospasm-related morbidity and all-cause mortality postaSAH secured by endovascular coiling. This double-blind, placebo-controlled, phase III trial randomized patients...

This study arose from a need to systematically evaluate the clinical and angiographic outcomes of intracranial aneurysms treated with modified coils. We report the procedural safety and clinical outcomes in a prospective randomized controlled trial of endovascular coiling for ruptured and unruptured intracranial aneurysms, comparing polymer-loaded...

Clazosentan, an endothelin receptor antagonist, significantly and dose-dependently reduced angiographic vasospasm after aneurysmal subarachnoid haemorrhage (aSAH). We investigated whether clazosentan reduced vasospasm-related morbidity and all-cause mortality. In this randomised, double-blind, placebo-controlled, phase 3 study, we randomly assigned...

In this issue of the American Journal of Neuroradiology are 2 articles examining the risks associated with the treatment of unruptured intracranial aneurysms (UIAs).[1][1],[2][2] These articles used the National Inpatient Sample (NIS) data base. This samples one-third of all nonfederal hospital

The purpose of this study was to review current treatment options in acute ischemic stroke, focusing on the latest advances in the field of mechanical recanalization. These devices recently made available for endovascular intracranial thrombectomy show great potential in acute stroke treatments. Compelling evidence of their recanalization efficacy...

Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is a frequent but unpredictable complication associated with poor outcome. Current vasospasm therapies are suboptimal; new therapies are needed. Clazosentan, an endothelin receptor antagonist, has shown promise in phase 2 studies, and two randomized, double-blind, placebo-controlled...

Purpose To report the 6 month angiographic results in patients treated with Cerecyte or bare platinum coils in a prospective randomized trial. Materials and methods 500 patients undergoing coil treatment of a ruptured or unruptured cerebral aneurysm in 23 centers in Europe, North America and Japan were randomly assigned to receive either Cerecyte C...

Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with substantial case-fatality. Our purpose was to examine which clinical and neuro-imaging characteristics, available on admission, predict 60 day case-fatality in aSAH and to evaluate performance of our prediction model. We performed a secondary analysis of patients enrolled in the...

The management of unruptured intracranial aneurysms (UIAs) remains controversial. The International Study of UIAs (ISUIA) found low rates of rupture and appreciable treatment risks. This finding could be interpreted as suggesting that many UIAs should not be treated. Coiling technology has continuously improved over the years and, since the publica...

The introduction of detachable coils revolutionised the management of patients with intracranial aneurysms and is now considered a first-line treatment in our institution. The purpose of this study was to review 10 years of experience with this method. A retrospective review of prospectively collected data on 711 patients undergoing endovascular tr...

Aneurysms need accurate millimeters (mm). Direct millimeters were lost with digital subtraction angiography (DSA) years ago, with measurements in pixels. Advances in DSA can now give inherent millimeters. The Cerecyte aneurysm coiling trial's angiographic core lab assesses images from compact disc (CD). External fiducials for millimeter calibration...

The long term follow up of patients entered in the ISAT trial continues to give insight into a number of important research questions. What is the natural history of early rebleeding? There was a marked variation in time taken from ictus to both randomisation and to treatment seen between ISAT centres with a range of 0-28 days. During this period t...

The proliferation of new endovascular devices and therapeutic strategies calls for a prudent and rational evaluation of their clinical benefit. This evaluation must be done in an effective manner and in collaboration with industry. Such research initiative requires organisational and methodological support to survive and thrive in a competitive env...

A significant minority of aneurysms treated by endovascular means undergo additional subsequent therapy to treat aneurysm recurrence. Our study was undertaken to determine the risk of additional coil embolization of aneurysms recurring following endovascular therapy. Patients were identified during a 10-year period from prospectively collated data...

The preventive treatment of unruptured aneurysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinic...

The present purpose is to define the sensitivity of the superiority of coil embolization observed in the International Subarachnoid Aneurysm Trial (ISAT) according to the rate of late rebleeding over a reasonable range, and to find the range of rebleeding rates for which it may be overturned. In the ISAT, coil embolization appears to be safer than...

There is currently no evidence that treatment of unruptured aneurysms is beneficial. Confronted with the uncertainty, many clinicians are attracted by an individual calculus of risks using numbers extracted from subgroup statistics of observational studies or natural history data. The so-called natural history of unruptured aneurysms refers to a pu...

Concern has been expressed about the applicability of the findings of the International Subarachnoid Aneurysm Trial (ISAT) with respect to the relative effects on outcome of coiling and clipping. It has been suggested that the findings of the National Study of Subarachnoid Haemorrhage may have greater relevance for neurosurgical practice. The objec...

UK stroke mortality data suggest that the incidence of haemorrhagic stroke has fallen in the past 20 years, but these data do not include deaths of individuals aged 75 years or over. Trends in the older population might differ, since cause varies with age. Our aim was to investigate changes in the population-based incidence of intracerebral haemorr...

Preventive treatment of unruptured intracranial aneurysms is often performed but has never been proved beneficial as compared to conservative management. In a context of uncertainty, the 'best treatment' that can be offered to each individual is a chance to be treated and thus to be protected from rupture of the aneurysm, and an equal chance not to...

Section Editor: Graeme J. Hankey MD, FRCP Patients who have had an aneurysmal subarachnoid hemorrhage (SAH) are at very high risk of rebleeding if the aneurysm is not treated. The standard treatment for several decades has been surgical clipping of the neck of the aneurysm. In recent years, an alternative, the introduction of detachable coils to...

Patients who have had an aneurysmal subarachnoid haemorrhage (SAH) are at very high risk of rebleeding if the aneurysm is not treated. The standard treatment for several decades has been surgical clipping of the neck of the aneurysm. In recent years, an alternative, the introduction of detachable coils to occlude the aneurysm, has become more commo...

Diffusion weighted brain imaging (DWI) is used in acute stroke, and also shows an acute ischaemic lesion in most transient ischamic attack (TIA) patients scanned acutely. However, it may also be useful in identifying subacute ischaemic lesions in patients with minor stroke or TIA who present several weeks after symptom onset. This study investigate...

Surgery is currently the standard treatment for spinal dural arteriovenous fistulae (DAVF). Endovascular embolisation of these lesions using N-butyl cyanoacrylate (NBCA) has a high success rate. Onyx is a new liquid embolic agent whose viscosity makes it suitable for treatment of spinal DAVF where penetration into the proximal radicular vein is req...

The pathological substrate and clinical significance of white matter low density change on computed tomography (CT) remains incompletely understood, hampered by suboptimal rating scales. We developed a new scale and applied it to 647 CTs in 382 patients. White matter change was categorised by region (anterior and posterior frontal, parietal, occipi...

To elucidate the effect of treatment timing on procedural clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH) for patients treated by endosaccular coil embolization. A group of 327 patients who were consecutively treated, during a 46-month period, for ruptured intracranial aneurysms by coil embolization within 30 days after SAH were ev...

In this paper the authors describe the first use of a new liquid embolic agent (Onyx) to treat spinal cord arteriovenous malformations (AVMs). Because its properties make it more predictable to use than currently available liquid agents, the authors believe that this material has great potential in the endovascular management of both spinal cord an...

During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding. Patients were followed for 6 to 65 mon...

Coil embolization of berry aneurysms is a relatively new treatment whose long-term efficacy has yet to be established. The purpose of this study was, first, to attempt to identify factors that might be important in predicting success both at the time of treatment and at the time of follow-up angiography, and, second, to study changes in the aneurys...

Object. During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully heated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term. efficacy in protecting patients against rebleeding, Methods. Patients were followe...

Background The management of unruptured intracranial aneurysms requires knowledge of the natural history of these lesions and the risks of repairing them. Methods A total of 2621 patients at 53 participating centers in the United States, Canada, and Europe were enrolled in the study, which had retrospective and prospective components. In the retros...

An endovascular approach, embolizing intracranial aneurysms with electrolytically detachable coils, is a new minimally invasive treatment of aneurysms. Reviewing our experience with 13 patients aged 70 years or more, 12 patients were treated successfully. Over an average follow-up period of 8 months, there was only one death which might be attribut...

Patients with subarachnoid haemorrhage due to the rupture of aneurysms unsuitable for craniotomy and clipping have been treated by coil embolisation within three weeks. Sixty nine of 75 consecutive patients were successfully treated. Procedure related complications occurred in 10 patients, resulting in permanent neurological deficits in three and o...

To analyze the anatomic consequences of selective amygdalohippocampectomy (AH) in patients with hippocampal sclerosis and to correlate the clinical outcome with the MR appearance. Seventeen patients were examined with clinical and neuropsychologic examination and cranial MR after AH (7 transcortical AH, 10 trans-Sylvian AH). The clinical and neurop...

The authors report the pathological and histological findings in two patients with giant partially thrombosed aneurysms who were treated by means of Guglielmi detachable coils with subtotal occlusion of the aneurysms. Autopsies of these patients were performed 2 and 6 months after endovascular treatment. The histological findings revealed coils emb...

The case of an atypical carcinoid tumour of the larynx is described in a 65-year-old man. This rare tumour may present diagnostic difficulties, but the diagnosis should be considered in a patient presenting with symptoms of local or referred pain and an apparently small, non-ulcerating supraglottic tumour. Immunocytochemistry has an important role...

Two patients with giant basilar tip aneurysms underwent coil embolization, one with both platinum fiber and platinum Guglielmi detachable coils and the other with Guglielmi detachable coils only. In both cases, spontaneous intraaneurysmal thrombosis occurred outside the coil mass, presumably a result of disruption of the intraaneurysmal flow patter...

The traditional association between anosognosia for hemiplegia and the right hemisphere was investigated in 31 patients with unilateral temporal lobe pathology during intracarotid sodium amytal testing (ISA) before epilepsy surgery. Recall of arm weakness was examined by questioning at the end of the test, when memory for items presented during the...

Twenty patients with aneurysms were studied with transcranial Doppler before, during and after endovascular treatment with Guglielmi detachable coils. Catheterization of the anterior circulation decreased middle cerebral artery velocities by 15-20%. Inserting coils into the aneurysms increased pulsatility indices modestly, reflecting a stiffening o...

Endosaccular packing of inoperable aneurysms with electrolytic platinum coils was performed in 50 patients. Complete embolization of the aneurysms was achieved in 100% of small, 95% of large and 85% of giant aneurysms, with combined procedural and periprocedural morbidity and mortality rates of 6 and 4%, respectively. Follow-up angiography of 42 an...

The diagnosis of Alzheimer’s disease (AD) cannot be made definitively in life. The only reliable diagnosis is by neuropathological examination of the brain. We have followed a series of 200 patients with clinical evidence of dementia using serial temporal lobeoriented; 58 of these patients have now died, and neuropathological examination of the bra...

In one year, cerebral angiograms were performed for intracranial haemorrhage (ICH) on 334 patients. No cause for haemorrhage could be identified in 41 (12%), 30 of whom had predominantly subarachnoid (SAH) and 11 predominantly parenchymal haemorrhage (PH). These patients were prospectively examined by cranial MRI 1-6 weeks after the ictus. The MRI...

The symptoms of Alzheimer's disease are associated with pathological change and loss of neurons in the medial temporal lobe. By yearly temporal-lobe-oriented computed tomograms the average rate of atrophy of the medial temporal lobe was 15.1% per year (95% CI 10.0, 20.2) in 20 patients with histopathologically, confirmed Alzheimer's disease and 1.5...

Sixty surviving patients from a community-based stroke register who had computerised tomography (CT) scan evidence of a single brain lesion were interviewed three to five years after their first ever stroke. Depression (DSM-III-R major depression, partially resolved major depression, and dysthymia) was present in 11 (18%) of the patients and was as...